Individual
JEFF WILLIAM SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
12805 HIGHWAY 55, SUITE 200, PLYMOUTH, MN 55441-3859
(612) 723-0408
(763) 210-5379
Mailing address
12805 HIGHWAY 55, SUITE 200, PLYMOUTH, MN 55441-3859
(612) 723-0408
(763) 210-5379
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
18053
MN
Other
Enumeration date
02/05/2009
Last updated
03/05/2013
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